HomeMy WebLinkAboutPermit Building 1989-5-3
'111l~I'[CIIU/l L1il[ LIlY Uf SI'RI/lufIElU NfORIlAI:.:1 Lo..,
1726-3769 ~~OIIBIIlATlON APPUCATlON/PERMlT . 726-3753
Job Address JOb:2 .: I ~~ ~AI N ~r. I ~~;~r,Y SOURCES: ~:: ~:;: ~:~;S5.
l.e9.1 Omript;on \(\O~ \ 04Y('{}) 11"ater lIeater SQ. FtQ. Other
lie,., Add 11.1 ter ~eD.
Ranf'Je _ -rence Demo Change/Use
IA I Val~ Hork: J! Other- -
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I Uui)(,jno Pernnt Info: Uescnbe Hork(i.e" Build Single
Familv l1esidence lIith flttached r.araoel
~_.\tfjl'G~oh1f~ ~~)
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Owner 0\'lVIA',,!1 ~Jli1o.A"'a...i1.llt..
.\Jdrcss /() 17 0 M~ 4.
~ . ~ ceO o.-L4-.17
constructiCjr NOIJI:,
Phone
,\JJress
DES I Grl r l^/1
Phone
(name) (ilddress) (lies,. no.)
f"vetl1P'r~,..,.AvrLht,".1PJo ~r~ .41~"
Primary
Structura 1
Electrical
!1echilnica 1
COtlTRAC~,9 _ Jllclme)
Gener.lll 'j'fJ (!/.(!~ .-
(addre,>s)
, (1 ir:... no.l
Plumbino
[lcctrical
fl~<,:h,lnic.,l
PlUlIBlllG
ELECTRICAL
i:U.
il CIIARGE
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JIlL..'
1..liL J:lJARGE I
Residence of
Each single fixture
SQ. FT.
-----I Relocated building
(new fix. additional)
IS.F. r.esldencc
(I bath \
-----/OuPlex (1 bath) each
IAdditi'onal bath
~!ater service
-1--
New circuits alts.
or extensions
ISERVICES
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(exnlresl
{nhone no. I
q74-/)'L
?74~ . a?3?c,
(pxnirp~l (nhnnp no.
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MECI!J\NICAl
furnace/burner to
BTlI's
..E.E.L 1.l:1lARGE.
I Floor furnace'
and vent'
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Recessed wa 11
~n~~p hp~tp~ ~nrl
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'Electrical Contractor. the electrical portion of this per~it I
Supervisor and returned to the Building Division
! T cmpora ry
I Chanqe 1 n
rf'~ i d~nrf'
I !mul t i rami ly.
Inrtll~tri;d
~IOf
ConstructiClJ\ '1
exisUn9 I
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Sewer
1 Storm
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comm, or
CH!lf'1S.1
Sel'/er
Cor'I./lNO. FEEDERS
-+- Install/alt.er/. relocate
- _oi.H.ill~e.dPr~
Of amps./
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I TOTAL
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I Apol iance vent
~@oal'atp'
I Stationary evap.
cooler ,I.:"
I Vent fan with ~
sinole duct I'
I Vent. systef!l apart from I
heat.!nn or A.C. .
I ~leChdnjca I exhaust "
hnnrt itnd dUl"t '.
I Hood stove/heate'r I
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ISSUAr'CF OF PfR!HT
TOTAL CHARGES
I HAVE CM!UULl Y EXN1Jtj(O the com[J le led apf'J li.;a t ion for ~ermi t. and do hereby certify tha t a II informat ion hereon is true
and correct. and I further c~rtify that any and all work nerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the Stelte of Oref)on oertaining to the work described herein, and that lie OCCl!PAIlCY \'1ill be made
of any structure without the nermission of the Guilding Division. I further certify that !'t,y renistration "lith the Guilder's
Ooard is in full force and effect as re<1uired by nr..s 701.055. that if exempt the basis for exemDtion is noted hereon, and that...
only subcontractors ilnd et:lnlo.yees \'Iho. are in com~liance with OI~S 7r}1.055 ",ill be used on this nroJect.
IIA:lE(pleaso print~I=D ( ~
SIr.tlATURf ~---v-
Orf I FE lISE m,;:'y
Sf'!. Ft!J. rta in
SQ. rt~. Access
Sq. rtg. Other
ro~
Zone
fire 70ne
flood Plain
_ __Tyne/Cons t.
Bl?drooms
Stories
Units
Occy LOi:ld
l)cc,V Group
om ~ f'f~
. I.
x
x
x
Value
Value
Value
TOTAL VALUATlOtl
BUllOlf'G PERI.1l1 __~14~~ PI.ln Ck. Conm/I nd S~stems Development
Ch,lr'lC<; itn~ 65!/Oldn Pror Fpp C .roe (1.5")
.Pldll [k. nes
Surcharf)cs ?JJ'L '301lB I do Per Fee
PlUI1nING PERMIT I Fence I
C!1argcs and ------------
Surchdrges I Of-mo I
. [lECTRICf..E rERI:IT I Sidewalk I
Char~Jl~S and ------------
Surcharges I A/e Pavin9 ITotal (OPlb. rermi t
/lECIIANICAl PEr.f111 J Curb (tIt ,- l
Charges and ------------ ?8.:)3
Surcharqes I jlOTA
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COMBINATION APPLICATION/PERMIT (CAP)
IV.
t. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example. Tax lot JOO. lane County Map Reference
II oj q3
Z. examele- Lot I. Block 3, Znd Addition to
~prlngfield [states
Name. etc. of owner and construction lender
Energy Sources
1. example- heat/~Icctrical c~JJn.9/or !n~~t!:......~
2. example- watct'heater/l!leclt'lcal/or !ooT"....
E. Square rootdgc or valudLion. clc. -
1. "examole. 1250 sq. .foot house. 500 sq. foot garage
2. example- if new project, check new _ if adc.Jilion,
Check add, etc.
F. BuiJding pennit information:
1. example - construct single family house with an
attaChed garage
2. examole - remodel existing garage into family room
J~ examole - convert single family residence into
restaurant (change of use) .
G. Value of work as defined in Section 3D3 (a) of the
Structural Specialty Code
II. OES IGN TEAI.I ANO COil TRACTORS
To avoid deSign or cOnSl,"uction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information Or job site-
corrections. etc.
Abbreviated Plumbing. Mechanical. & Electrical Schedules
A. Except where blank spaces OCCur in the description
portion of the Mechanical and Electrical Schedules.
the'applicant need fill-in only the No. Boxes adjacent
to the appropriate item{s) to be installed
8. fu11 Plumbing. Nechanical. and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item{s) to be installed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu I es
C. BUILDING OIVISION STAFF WILL FIll OUT ALL FEfS AllD
CHARGES Oil THE SCHEOULES
D. As noted on the CAP. the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical :labe1.
Applicant to sjgn and date
Whenever possible. the initial application will be used as
a workSheet only. .Where possible. Building Division Staff
will prepare a type written copy and return it La the
applicant at the time the actua-J permit is issued for his
Signature.
Fees and Charges
Plan check fees are due and payable at the time of the
application. and no plans will be processed until these
fees are paid. All other fees and charges are due and
-: payable when the permit is issued.
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II.
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V. FOR OFF'CE USE OrlLY
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PERMIT VALIDATION
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1*\~fJ340
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Pe rm i t
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArlCY:
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Permit applicant exempt from registration with the Guilder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
name
signature
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,~
date
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